Health Insurance Enrollment Trends; a Fourth Quarter Segment-by-Segment Comparison
May 7, 2026
Approximately 318 million people received medical coverage from U.S. health insurers as of December 31,2025, based on data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services) and various state agencies. This number is down 2.3 million members from December 31, 2024. Fourth quarter enrollment trends indicate membership gains for Medicare Advantage (MA), and Employer Group, self-funded administrative services only (ASO) business, while the Individual, Medicaid, and Employer Group Risk segments experienced year-over-year declines.
Market analysts throughout the health insurance industry rely on enrollment data and segment performance metrics to gain better insights into health plan market share and competitive positioning. Many companies conduct their competitive assessments by using Mark Farrah Associates’ (MFA) Health Coverage Portal™. In this brief, MFA assesses the latest year-over-year enrollment trends, comparing 4thquarter 2025 with 4th quarter 2024 segment membership.
Segment Overview
As of December 31, 2025, 987,140 more seniors chose a Medicare Advantage (MA) plan from the previous year. The Employer-Group ASO (Administrative Services Only) segment gained over 1.5 million members. In contrast to these enrollment increases, the Individual market for on-and-off exchange business lost roughly 489,000 members and the Employer-Group risk segment, including Federal Employees Health Benefit Plans (FEHBP) business declined by 1.4 million members. Additionally, Medicaid decreased by approximately 2.9 million members, year-over-year.
Segment by Segment Enrollment Trends
- Medicare Advantage (MA) market penetration remains strong; however, with 51.8% of the 69.6 million people eligible for Medicare enrolled in an MA plan, the growth rate has noticeably slowed. Fourth quarter 2025 MA membership stood at over 34.4 million, a year-over-year increase of over 987,000 members, representing 3% growth, from 4Q24.
- With 20 fully state-based marketplaces (SBMs) and 28-31 federal/partnership platforms, Individual health enrollment fell in 2025. Total year-end Individual membership for both on-and-off the exchange decreased -1.9% from 25.5 million members in 4Q24 to just under 25 million at the end of 2025. Individual enrollment began dropping in 2025 due to federal policy changes and the scheduled expiration of enhanced subsidies (premium tax credits).
- Employer-group, self-funded ASO contracts remain a viable option for businesses as they can be more cost effective than risk-based plans. Self-funding is specifically common among larger companies as they can disperse the risk of steep claims over many workers and their dependents. Membership for this segment encompassed 42% of total health enrollment for 4Q25. According to MFA’s recent estimates, Employer-group ASO membership was over 134.5 million, an increase of 1.5 million members, or a 1.1% increase, from 4Q24.
- As of December 31, 2025, just over 75.3 million beneficiaries received healthcare through Managed Care Organizations (MCOs) and Fee-for-Service type Medicaid programs based on membership filed in statutory financial reports from the NAIC and the CA DMHC, as well as state reported Medicaid and CMS reported Medicaid enrollment reports. This is a 2.88 million member, -3.7%, decline from the previous year. This recent drop in enrollment is due to policy changes related to tightened eligibility requirements and declines in reimbursements for state programs.
Note: a portion of CHIP (Children’s Health Insurance Program) enrollment is reported in the Individual segment within statutory reporting.
- Fourth quarter 2025 figures indicated Employer-group risk membership, including Federal Employees Health Benefit Plans (FEHBP) members, experienced yet another decrease between 4Q24 and 4Q25 despite Employer-groups being the leading source of health coverage in the U.S. Membership for the Employer-group risk segment as of December 31, 2025 was approximately 48.5; a -2.8% decline from 49.9 million the previous year.
About the Data
The data used in this analysis brief was obtained from Mark Farrah Associates' Health Coverage Portal™ database. Employer group ASO figures may be estimated by Mark Farrah Associates using credible company and industry resources. Individual membership reported by some carriers may include CHIP (Children’s Health Insurance Program). These adjustments may have resulted in moderate understatement or overstatement of enrollment changes by segment. Findings reflect enrollment reported by carriers with business in the U.S. and U.S. territories. Data sources include NAIC (National Association of Insurance Commissioners), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services) and various state agencies. MFA will continue to report on important plan performance and competitive shifts across all segments.
About Mark Farrah Associates (MFA)
Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, 5500 Employer Health plus, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For more information about these products, refer to the product pages and brochures available under the Our Products section of the website (www.markfarrah.com), or call 724-338-4100. Healthcare Business Strategy is a FREE brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email to the "Subscribe to MFA Briefs" section at the bottom of this page.